Judith Grisel was only 13 years old when she got drunk. It was her first time, but the buzz that alcohol produced in her brain was enough to start a series of events that would lead her into the drug world. She started with alcohol; later, with marijuana and cocaine; until she ended up shooting heroin through her veins. Commonly, this story would end with the boring clichés: “she eventually would find help”, “she ended up in a hospital” or the grimmest of them all, “sadly, she died of an overdose”. But, this is not that kind of story; neither is Judith Grisel that kind of person. Our subject, “through a series of circumstances” became sober. She went back to college and found herself finishing a Ph.D. in Behavioral Neuroscience. Why? To tackle the problem that tormented her early years: addiction.
Judith Grisel and the Brain on Drugs
Never Enough for the Brain
Grisel, 30 years later, has written a powerful book, Never Enough: The Neuroscience and Experience of Addiction (Doubleday, 2019), that puts forward the latest developments of the world of science, regarding the Central Nervous System (CNS) and the brain. Any book on addiction will find itself dabbling with the drug war and what to do with the addicts, but that’s not the story for Grisel. Arguably the best part of her writing is the introspection that she brings every now and then when she’s describing the function of a drug in the brain. Instead of looking for some story to relate to, Grisel manages to combine scientific facts with the story of her life (when she was an addict).
The central premise of the book is noted from the start. It came to Grisel through a comment that a friend of hers -both addicts at the time- made when using cocaine: “there will never be enough drugs.” Indeed, there is never enough. Grisel starts from the basics: marijuana through all the way to psychedelics. In every chapter, the brain’s adaptability is featured, with each chemical component creating havoc in the behavior of the drug user.
The brain’s capacity for drugs has been written before. The organ has a reward system that releases dopamine -a neurotransmitter in the brain- which is critical for pleasure, movement, and motivation. Many drugs target the dopamine pathways of the brain -some claim that it hijacks the pleasure systems of the brain-, developing a craving for more. Although this is bad enough, the effects of drugs don’t end there. With more stimulation from the drug in the pleasure centers of the brain (the dopamine system), the organ starts to adapt and to create tolerance. This becomes the devil’s bargain of the drug, because, with tolerance, the consumer starts to increase the daily quantity that it takes. It’s with this, that the brain keeps increasing tolerance and having less pleasure, with the now-addict craving for more powerful substances. Since the craving dominates the thoughts of the addict, he/she can only think of getting high. Here is when relationships, family, and workplaces are destroyed for the sake of pleasure.
What Drugs do to Humanity
Although those scientific facts are important, Grisel’s book shines when it goes beyond the biological explanations. Often, the neuroscientist (Grisel) tries to relate the biological components with not just the brain, but, with the whole person. When writing about the strong adaption of the brain to cocaine, Grisel recalls a vivid memory of how she (an ex-addict) reacted to the mere image of a needle. She was volunteering in a laboratory to get research experience when, in one of the procedures, which involved inserting a needle into a rat, she felt the following:
“…I pulled back the needle filled with blood, I heard clamorous ringing in my ears and a taste in my mouth that were characteristic of cocaine going into my vein. It was years later, in a completely different context, and I had not a whit of desire to use at that moment, but just seeing blood filling the syringe cause an instantaneous reaction. I let my colleague finish the injections and went back to my dorm sobered by the astounding power of memory. [emphasis by Judith Grisel]“
The sheer vividness of the account permeates throughout the book. Just when Grisel is losing the reader with the technical jargon of the field, she brings the narrative back to the powerful effects of drugs in her life. When talking about the ability of THC to make any perception stand out (cannabinoids exalt common information in the brain, hence the stoner laughing at bad comedy), Grisel recalls how miserable the first months were without weed. “Though I was in a new environment, with new friends and countless novel experiences, I remember very little and experienced everything as bland beyond belief”, recalls the author.
Grisel jumps to the opioid epidemic, the alcohol crisis, and the persistent presence of tobacco in the current century. On the former (opioids), the main reason for the crisis is the complexity and diversity that these drugs have; moreover, the fact that these chemicals are produced in the brain, becoming critical for “sex, attachment, and learning.” Opioids tend to be utilized for pain, “mimicking endorphins” (the body’s way to deal with pain). The trick of the drug is that the withdrawal features a drawback called anti-opioid. That last fact, anti-opioid, in the natural world, let’s the organism know that he’s in pain (which is the opposite of the opioid, that eases the intense pain). As the reader might already conclude, it becomes troubling when you are ingesting a drug that treats pain but also features the setback of anti-opioid (pain).
On alcohol, Grisel calls it a “sledgehammer” and a real potency in the drug crisis; noting the fact that it killed “twice as many people in 2016 as prescription opioids and heroin overdose combine, and even this number would be almost three times higher if it included drunk-driving related death.” Between alcohol’s ability to enhance the inhibitory neurotransmitter, GABA, and the excitatory neurotransmitter, glutamate, the drug becomes a source of blackout and bad behavior (the combination of these effects, GABA inhibiting and glutamate being reduced, the brain’s neural processes start to slow down).
And yet, not everything is bad news in Never Enough. She writes positively about the prospect of psychedelics and what can they bring to the table as alternatives to other drugs to treat mental health. Also, another sense that one gets when reading each chapter, Grisel doesn’t ring the alarm on other drugs, like synthetics ones; she calmly draws from a variety of scientific studies to explain their effect on the brain and why they don’t end-up as the favorites of the addicts.
One example of this is when she talks about “Angel Dust”. Now, for those who aren’t familiar, this drug was known as phencyclidine. Previously used to become an anesthetic, the drug causes fatal side effects, like hallucinations, aggressive behavior, and agitation. Once, the late neurologist, Oliver Sacks, in the 1960s (the peak of the drug) went to a party in East Village in New York that promised the opportunity to try Angel Dust (these were the days that Sacks was out of control, trying all kinds of drugs). Sacks, in his memoir, On the Move, describes a jaw-dropping scene:
“I arrived a bit late -the party had begun- and when I opened the door, I was faced by a scene so surreal, so insane, that it made the Mad Hatter’s tea party seem, by comparison, the essence of sanity and propriety. There were almost a dozen people there, all of them flushed, some with bloodshot eyes, several staggering. One man was uttering shrill cries and leaping about the furniture; perhaps he fancied himself chimp. Another was ‘grooming’ his neighbor, picking imaginary insects off his arms. One had defecated on the floor and was playing with the feces, making patterns in it with an index finger. Two of the guests were motionless, catatonic, and another was making faces and blathering, a farrago which sounded like schizophrenic ‘word salad’. [emphasis by me]“
It is horrifying the vision that Sacks depicts. But, for Grisel, she calmly explains why these types of drugs became less popular rather than the go-to substance among drug users. With the same perspective that made her appreciate the potency of drugs, Grisel notes that since this drug (Angel Dust) had immediate harmful effects, like “delirium”, the drug user almost always tried to find a more suitable and “safer” type of drug; opening the doors to the current abuse of opioids and tranquilizers. (That does not mean that she doesn’t warn the reader, but, she calmly concentrates her efforts on the one that is doing the real damage, like tobacco.)
What to Do With Addiction?
The potency of Grisel’s account is found in the last chapters of the book. Although the prose is full of drug-fueled narratives, the solutions and explanations become sober writings on addiction. When musing on why some people become more addictive than others to drugs, Grisel reflects about her previous thoughts that made her ask that same question:
“It wasn’t as if my behavior was so outside the norm. Practically everyone I knew used chemicals. Why substances get the best of them? The girl I was thrown out of ninth grade with, for example, was well on her way to a successful career and a happy home life when I landed in the treatment center. We seemed to start off on the same road, so it didn’t seem right that I was the one to veer into a ditch, while she coasted down what looked to be easy street. In fact, the world seemed full of people who were having their cake and eating it too. My family, friends, and co-workers all drank, and many other drugs, but somehow, they didn’t end up trading themselves for one last bump, hocking the family jewels, or wrapping around poles. Streets and clubs worldwide are filled with users enjoying themselves -happy and just a little blitzed. How to explain the fact that only a subset of us pursue this path all the way to an early grave? [emphasis added by me]”
In the end, Judith Grisel resigns to what she has already discovered. The fact that people’s addiction is a combination of genes, early exposure, environment and the chemical compositions of drugs. As Grisel reluctantly explains, none of them assure scientists which person will become an addict -for now. She even acknowledges that even though neuroscience promised to explain “the seemingly inexplicable complexities inherent in the human behavior”, the field still is behind in decoding the problem of addiction.
In fact, the thing that brought Grisel to rethink her life and get help was not strong punishments by the state or shame by society. The reality came from an unexpected place, her father. Like many addicts, her family drifted off from her, after being unable to live with a daughter that used drugs regularly and was having a chaotic life. Grisel, who came from a middle-class background, was plummeted into tears when years later, her father, who refused to accept her drug problem, invited her to a restaurant to celebrate her birthday. The kind gesture on still wanting to see his daughter, even in the darkest of times, opened the eyes of Grisel; as a stroke of insight, she got help, turned to the neurosciences and shared her vivid account. One feels that that’s the biggest take-away of Never Enough. That someone so deep into the drug world could deliver the scientific truth of addictions, give an introspective example of such world, and finally reflect on the bad policies that still torment drug users all over America.
Never Enough: The Neuroscience and Experience of Addiction
by Judith Grisel
Doubleday, Hardcover, pp. 256
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Copyright by World Economic Forum / Christian Clavadetscher